Congestive Cardiac Failure- Causes, Signs & Symptoms And Treatment

A 40 Year  old man is admitted to CCU with the diagnosis of systolic dysfunction congestive cardiac failure. Regarding CCF answer the following questions:

1. What causes Congestive heart failure? 

The causes of CHF are numerous and include: 

• CAD (most common), 
• dilated cardiomyopathy arising from toxins such as alcohol and doxorubicin,  idiopathic causes, infection, and collagen vascular disorders. 
• hypertension, 
• cardiac arrhythmias, 
• cardiac valvular disorders, 
•  hypertrophic cardiomyopathy, and 
• restrictive cardiomyopathies (caused by disorders such as amyloidosis, hemochromatosis, and sarcoidosis). 

CHF occurs when there is a decrease in cardiac contractility, which leads to decreased cardiac output that does not keep up with the body’s physiologic demands. Initially, this inability to keep up with physiologic demands may only be seen with exercise. However, as the disease progresses, signs may also occur at a resting state.

2. What are the signs and symptoms of CCF? 

Symptoms include :

• shortness of breath; 
• paroxysmal nocturnal dyspnea, which awakens the patient and causes severe shortness of breath and diaphoresis, causing the patient to sit up for prolonged periods; 
• orthopnea (dyspnea in the recumbent position); and 
• peripheral swelling. 

Signs include:

• jugular venous distention more than 4 cm elevated from the sternal angle with the patient’s head elevated at a 45-degree angle, 
• hepatomegaly,
• hepatojugular reflux, 
• S3 heart sound, 
• peripheral edema, and 
• pulmonary rales (the most common finding).

3. How will you treat a patient with congestive heart failure? 

Treatment consists of:

•  a low-sodium diet, diuretics, 
• ACE inhibitors (ramipril, enalapril, lisinopril) or
• angiotensin II-receptor blockers (losartan, candesartan) if unable to tolerate ACE inhibitors,
• β-blockers (carvedilol, long-acting metoprolol succinate), 
• digoxin (particularly in CHF complicated with atrial fibrillation), and 
• other afterload-reducing medications (e.g., hydralazine, isosorbide dinitrate). 

CCBs, especially verapamil, should be avoided because of their negative inotropic effect on the heart; however, they are useful in cases of CHF caused by diastolic dysfunction and hypertrophic cardiomyopathy.